The dramatic rise in opioid overdose fatalities is overwhelming communities across the US. This study will conduct a rigorous evaluation of the nation's first ?public health court? known as the Opioid Intervention Court (OIC) model that was established in Buffalo, NY, in May 2017. The research objective of this proposal is to evaluate this strategy implemented in collaboration with local public health to infuse public health into the public safety and justice system response. Under Memorandum of Agreements, the applicant is fully partnered with the Erie County, NY Department of Health on behalf of the Erie County Opioid Epidemic Task Force (ECOETF) that includes the New York Unified Court System, 8th Judicial District. The Commissioner of Health, Dr. Gale Burstein, is fully involved as an investigator and is the Director of the ECOETF that is implementing strategies to address the opioid epidemic, including the OIC model. The OIC model was a public health response to three drug court defendants fatally overdosing before their 2nd court appearance in a single week in 2016, indicating that the traditional drug court model (with weekly appearances) needed to be modified to save lives. The OIC model was designed to get non-violent users into treatment within hours of their arrest instead of weeks. It requires daily check-ins with the judge, focuses on immediate Medication Assisted Treatment (MAT) and opioid use disorder treatment (a public health approach to save lives) and once stable, transfers participants to the traditional weekly drug courts. It is important to note that this OIC model has served as a catalyst for other localities to adopt such an innovative infusion of public health approaches into the drug court response. However, to date, there has not been a rigorous evaluation of its effectiveness. Using a quasi-experimental research design, we will compare outcomes of Opioid Intervention Court participants with a comparison group of participants enrolled in a traditional Drug Treatment Court (tDTC). Specifically, we will address the following aims: Aim 1: Treatment Impact- To examine differences in time to treatment initiation on the basis of OIC vs. tDTC and to examine changes in substance use over time (i.e., opioid use, other illicit drug use, alcohol use and tobacco) on the basis of the OIC vs. tDTC; Aim 2: Health Impact- To examine changes in mental health (e.g., symptoms of depression, role limitations due to mental health) and physical health (e.g., pain, role limitations due to physical health) over time on the basis of the OIC vs. tDTC; Aim 3: Recovery Impact- To examine changes in social and environmental factors related to recovery (e.g., housing stability, employment, social connectedness); and, Aim 4: Justice Impact- To use court records to examine justice related outcomes (e.g., adherence to court appointments, drug related arrests, non-drug related arrests, incarceration) for individuals on the basis of OIC vs. tDTC. Results from this study will answer key questions related to the translation of the nation's first ?public health court? and will inform future practice and policy to address this crisis by infusing public health into the public safety and justice system.